Prevalence of non-accidental trauma among children at ACS verified pediatric trauma centers

Child abuse remains a national epidemic that has detrimental effects if unnoticed in the clinical setting | Journal of Trauma and Acute Care Surgery

Background: Extreme cases of child abuse, or non-accidental trauma (NAT), have large financial burdens associated with them due to treatment costs and long-term effects of abuse. Clinicians that have additional training and experience with pediatric trauma are better equipped to detect signs of NAT and have more experience reporting it. This additional training and experience can be measured by using the American College of Surgeons (ACS) Pediatric Trauma Verification. It is hypothesized that ACS verified Pediatric Trauma Centers (vPTCs) have an increased prevalence of NAT due to this additional experience and training when relative to non-ACS vPTCs.

Conclusions: The greater prevalence of NAT at vPTCs likely represents a more accurate measure of NAT among pediatric trauma patients, likely due to more experience and training of clinicians.

Full reference: Bogumil, D.D.A. et al. (2017) Prevalence of non-accidental trauma among children at ACS verified pediatric trauma centers. Journal of Trauma and Acute Care Surgery: Published online: 20 June 2017

 

Ultrasound for children with abdominal trauma

Despite evidence showing that the routine use of sonography in hospital emergency departments can safely improve care for adults when evaluating for possible abdominal trauma injuries, researchers at UC Davis Medical Center could not identify any significant improvements in care for pediatric trauma patients | ScienceDaily

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The findings, which resulted from a randomized clinical study involving 925 children with blunt torso trauma who were evaluated in the emergency department at the medical center, showed no difference in important clinical outcomes. The outcomes assessed were developed for the study mainly based on previous research in injured adults.

The UC Davis team investigated the Focused Assessment with Sonography for Trauma (FAST) to determine whether the use of the FAST examination could safely lead to a decrease in the use of computed tomography (CT) scans for children, and other outcomes. FAST is a bedside ultrasound examination using a portable ultrasound machine. It has not been routinely used in the initial emergency department evaluations of injured children. CT scans represent the “gold standard” in diagnostic imaging for clinicians, including the identification of intra-abdominal injuries, but they also pose a greater radiation risk for children than they do for adults.

Blood test shows promise in detecting abusive head trauma in infants

Researchers have developed and refined a blood test that could help clinicians identify infants who may have had bleeding of the brain as a result of abusive head trauma, sometimes referred to as shaken baby syndrome | ScienceDaily

The serum-based test, which needs to be validated in a larger population and receive regulatory approval before being used in clinical practice, would be the first of its kind to be used to detect acute intracranial hemorrhage, or bleeding of the brain. Infants who test positive would then have further evaluation via brain imaging to determine the source of the bleeding.

However, approximately 30 percent of AHT diagnoses are missed when caretakers provide inaccurate histories or when infants have nonspecific symptoms such as vomiting or fussiness. Missed diagnoses can be catastrophic as AHT can lead to permanent brain damage and even death.

Read the full commentary here

Read the original research abstract here

Selecting children for head CT following head injury

Kemp, A. et al. Archives of Disease in Childhood.  Published Online: 22 July 2016

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Objective: Indicators for head CT scan defined by the 2007 National Institute for Health and Care Excellence (NICE) guidelines were analysed to identify CT uptake, influential variables and yield.

 

Main outcome measures: Number of children who had CT, extent to which NICE guidelines were followed and diagnostic yield.

Results: Data on 5700 children were returned by 90% of eligible hospitals, 84% of whom were admitted to a general hospital. CT scans were performed on 30.4% of children (1734), with a higher diagnostic yield in infants (56.5% (144/255)) than children aged 1 to 14 years (26.5% (391/1476)). Overall, only 40.4% (984 of 2437 children) fulfilling at least one of the four NICE criteria for CT actually underwent one. These children were much less likely to receive CT if admitted to a general hospital than to a specialist centre (OR 0.52 (95% CI 0.45 to 0.59)); there was considerable variation between healthcare regions. When indicated, children >3 years were much more likely to have CT than those <3 years (OR 2.35 (95% CI 2.08 to 2.65)).

Conclusion: Compliance with guidelines and diagnostic yield was variable across age groups, the type of hospital and region where children were admitted. With this pattern of clinical practice the risks of both missing intracranial injury and overuse of CT are considerable.

Read the full article here

Acceptance of Shaken Baby Syndrome and Abusive Head Trauma as Medical Diagnoses

Narang, S.K. et al. The Journal of Pediatrics. Published online: 22 July 2016

Objective: To assess the current general acceptance within the medical community of shaken baby syndrome (SBS), abusive head trauma (AHT), and several alternative explanations for findings commonly seen in abused children.

Study design: This was a survey of physicians frequently involved in the evaluation of injured children at 10 leading children’s hospitals. Physicians were asked to estimate the likelihood that subdural hematoma, severe retinal hemorrhages, and coma or death would result from several proposed mechanisms.

Results: Of the 1378 physicians surveyed, 682 (49.5%) responded, and 628 were included in the final sample. A large majority of respondents felt that shaking with or without impact would be likely or highly likely to result in subdural hematoma, severe retinal hemorrhages, and coma or death, and that none of the alternative theories except motor vehicle collision would result in these 3 findings. SBS and AHT were comsidered valid diagnoses by 88% and 93% of the respondents, respectively.

Conclusions: Our empirical data confirm that SBS and AHT are still generally accepted by physicians who frequently encounter suspected child abuse cases, and are considered likely sources of subdural hematoma, severe retinal hemorrhages, and coma or death in young children. Other than a high-velocity motor vehicle collision, no alternative theories of causation for these findings are generally accepted.

Read the abstract here

Complete rest until symptom-free after concussion may not be best for recovery

American Academy of Pediatrics. ScienceDaily. Published online: 30 April 2016.

https://creativecommons.org/licenses/by-sa/2.0/

Image source: patricia m // CC BY-SA 2.0

New study found that youth who exercised within seven days of head injury had nearly half the rate of persistent post-concussive symptoms a month later

Rest has long been the cornerstone of concussion treatment. For sports-related head injuries, for example, current guidelines say children should avoid returning to play — and all other physical activity — until all concussion symptoms such as headaches are gone. New research however, suggests those who exercise within a week of injury, regardless of symptoms, have nearly half the rate of concussion symptoms that linger more than a month.

For the study, “Early Resumption of Physical Activities and Persistent Post-Concussive Symptoms Following Pediatric Concussion,” 3,063 children between ages of 5 and 18 who visited hospital emergency departments in Canada answered survey questions about their level of physical activity and severity of symptoms 7, 14, and 28 days after injury.

Contrary to recommendations, researchers said, most (58 percent) of the children still experiencing concussion symptoms resumed exercising a week after being injured, and more than three-quarters (76 percent) were physically active two weeks later.

Read the full commentary here

Nice Guideline update – Major Trauma: Assessment and Initial Management

This guideline covers the rapid identification and early management of major trauma in pre‑hospital and hospital settings, including ambulance services, emergency departments, major trauma centres and trauma units. It aims to reduce deaths and disabilities in people with serious injuries by improving the quality of their immediate care. It does not cover care for people with burns.

This guideline includes recommendations on:

Read the full guideline here